窦性心律伴完全性左束支传导阻滞的扩张型心肌病患者心脏再同步治疗后的长期随访

Long-term effect of cardiac resynchronization therapy in patients with dilated cardiomyopathy with sinus rhythm and complete left bundle branch block

目的评价窦性心律(窦律)伴完全性左束支传导阻滞(CLBBB)的扩张型心肌病(DCM)患者接受心脏再同步治疗(CRT)的远期效果。方法连续入组2013年1月至2016年12月在中国医学科学院阜外医院单中心诊断为DCM且同时具有窦律伴CLBBB、QRS时限≥150 ms、心功能Ⅱ~Ⅲ级(NYHA分级)、左心室射血分数(LVEF)≤35%并接受了CRT植入治疗的患者。术后每3~6个月门诊或电话随访1次,优化CRT参数以及药物治疗方案,并在随访结束时根据患者对CRT的应答性分组。结果入组112例患者,随访(38.2±7.4)个月后,46例(46/112,41.1%)患者表现为CRT超应答,27例(27/112,24.1%)患者表现为CRT无应答。共发生33例心血管事件,21例器械相关并发症。心血管事件的首位原因为心房颤动(17/33,51.5%)。无事件存活患者87例(87/112,77.7%),无事件生存时间为(44.0±1.8)个月。无应答组与有应答组各有13例和12例患者[(13/27,48.1%)对(12/85,14.1%)P<0.01],分别发生心血管事件19例和14例,无应答组与有应答组患者的无事件生存时间分别为(31.0±4.6)个月和(48.1±1.6)个月(P<0.01)。结论在接受CRT伴CLBBB的DCM患者中,无应答率较低,超应答率较高。心血管事件中最常见的为心房颤动,无应答组患者的心血管事件发生率明显高于有应答组。

Objective To investigate the long-term effect of cardiac resynchronization therapy(CRT)in patients with dilated cardiomyopathy(DCM)with sinus rhythm and complete left bundle branch block(LBBB).Methods From January 2013 to December 2016 in Fuwai Hospital,the patients who were diagnosed with DCM in our center and met the following criteria were recruited in our study:①with sinus rhythm and complete LBBB and QRS duration≥150 ms;②New York Heart Association(NYHA)functional classⅡ~Ⅲ;③left ventricular ejection fraction(LVEF)≤35%;④received CRT device implantation.All patients were followed up every 3 to 6 months to optimize the setting of CRT device and medication,and divided into two groups at the end of follow-up,responders and non-responders.Results One hundred and twelve patients were enrolled and followed up for(38.2±7.4)months.Among them,46(46/112,41.1%)were super-responders and 27(27/112,24.1%)were non-responders.A total of 33 cardiovascular events and 21 device related complications were recorded.The main cause of cardiovascular events was atrial fibrillation(17/33,51.5%).87 patients(87/112,77.7%)were cardiovascular event-free and the mean event free survival time was(44.0±1.8)months.19 and 14 cardiovascular events occurred in13 of non-responders and 12 of responders(13/27,48.1%vs.12/85,14.1%,P<0.01),respectively.The mean event-free survival time in non-responders and responders were(31.0±4.6)months and(48.1±1.6)months in responders(P<0.01),respectively.Conclusion In DCM patients received CRT with complete LBBB,the proportion of non-responders was relatively low,while that of super-responders was high.Atrial fibrillation was the most common cardiovascular event.The incidence of cardiovascular events in non-responders was significantly higher than that in responders.